Abstract
BACKGROUND: Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain condition characterized by irritation or compression of abdominal wall intercostal nerve branches called the anterior cutaneous nerves. Peripheral nerve stimulation (PNS) has become an effective treatment option for painful sensory neuropathic conditions, including mononeuropathies and nerve entrapment syndromes. This report describes a successful case of using temporary PNS to treat ACNES and reviews the available literature on the use of PNS for the treatment of ACNES. CASE PRESENTATION: A 38-year-old female with a complex abdominal medical and surgical history presented to the pain medicine clinic for intractable burning pain and pressure in the left upper quadrant of the periumbilical region. Given the patient's clinical history and the nature of her presenting symptoms, ACNES was considered as a potential diagnosis. The diagnosis was confirmed through a series of successful diagnostic rectus sheath nerve blocks. A two-month temporary peripheral nerve stimulator trial targeting the left anterior cutaneous nerve was completed, and it resulted in 80 % pain reduction at 3 and 6-month follow-up evaluations, with returning pain at the 8-month assessment. CONCLUSION: Chronic abdominal pain in patients with a complex history of abdominal surgery should alert pain specialists to consider the possibility of an ACNES diagnosis. Current evidence supporting PNS for ACNES is limited to a small number of case reports showing successful treatment; however, larger-scale and more robust studies are needed to determine the effectiveness and safety of this method. This study contributes to the existing body of literature, highlighting that PNS may serve as a valuable treatment option for individuals with chronic abdominal wall pain secondary to ACNES whose pain is refractory to conservative management strategies.